[1]颜斌,王哲,张瑜亮,等.Ⅲ型先天性食管闭锁胸腔镜手术治疗后吻合口狭窄的影响因素分析[J].临床小儿外科杂志,2025,(01):35-38.[doi:10.3760/cma.j.cn101785-202410044-007]
　Yan Bin,Wang Zhe,Zhang Yuliang,et al.Analysis of influencing factors for anastomotic stricture after thoracoscopic repair of type Ⅲ congenital esophageal atresia[J].Journal of Clinical Pediatric Surgery,2025,(01):35-38.[doi:10.3760/cma.j.cn101785-202410044-007]
点击复制

Ⅲ型先天性食管闭锁胸腔镜手术治疗后吻合口狭窄的影响因素分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 期数: 2025年01 页码: 35-38 栏目: 论著 出版日期: 2025-01-01
Title:
Analysis of influencing factors for anastomotic stricture after thoracoscopic repair of type Ⅲ congenital esophageal atresia
作者:
颜斌1;  王哲1;  张瑜亮2;  关茜思1;  余家康1;  钟微1;  何秋明1
1. 广州市妇女儿童医疗中心新生儿外科, 广州 510000;
2. 广州医科大学附属第三医院妇产科, 广州 510623
Author(s):
Yan Bin1;  Wang Zhe1;  Zhang Yuliang2;  Guan Xisi1;  Yu Jiakang1;  Zhong Wei1;  He Qiuming1
1. Department of Neonatal Surgery, Municipal Women & Children’s Medical Center, Guangzhou 510000, China;
2. Department of Obstetrics & Gynecology, Third Affiliated Hospital, Guangzhou Medical University, Guangzhou 510623, China
关键词:
食管闭锁;  先天性; 胸腔镜检查; 手术后并发症; 外科吻合口; 缩窄;  病理性; 吻合口漏; 影响因素分析; 儿童
Keywords:
Esophageal Atresia; Congenital; Thoracoscopy; Postoperative Complications; Surgical Stomas; Constriction;  Pathologic; Anastomotic Leak; Root Cause Analysis; Child
DOI:
10.3760/cma.j.cn101785-202410044-007
摘要:
目的 探讨Ⅲ型先天性食管闭锁(congenital esophageal atresia,CEA)患儿胸腔镜手术治疗后出现吻合口狭窄的影响因素。方法 回顾性分析2017年1月至2021年1月在广州市妇女儿童医疗中心接受胸腔镜手术治疗的Ⅲ型CEA患儿临床资料,将随访过程中出现吞咽困难、需行球囊扩张治疗的吻合口狭窄患儿归入狭窄组,无上述情况者归入非狭窄组,收集两组患儿性别、体重、胎龄、食管盲端距离、术后胃食管反流以及吻合口漏等情况,分析CEA手术后出现吻合口狭窄的相关因素。结果 本研究共纳入33例CEA胸腔镜手术患儿,其中7例术后发生吻合口狭窄。单因素分析结果显示,术后吻合口漏(χ2=7.757,P=0.005)、胃食管反流(χ2=6.046,P=0.014)与CEA患儿胸腔镜手术后吻合口狭窄的发生相关。多因素逐步Logistic回归分析显示,吻合口漏(OR=19.167,95%CI:2.868~189.764,P=0.004)是CEA患儿胸腔镜手术后出现吻合口狭窄的独立危险因素。结论 吻合口漏是胸腔镜手术治疗Ⅲ型CEA患儿出现术后吻合口狭窄的独立危险因素,建议针对吻合口漏优化手术操作和术后管理,以提高患儿术后生活质量。
Abstract:
Objective To explore the influencing factors of anastomotic stricture after thoracoscopy in children with type Ⅲ congenital esophageal atresia (CEA). Methods A retrospective analysis was conducted for clinical data of 33 children with type Ⅲ CEA undergoing thoracoscopy at Guangzhou Women & Children’s Medical Center from January 2017 to January 2021.Patients with dysphagia requiring balloon dilatation during follow-ups were categorized into stricture group while those without these complications were assigned into non-stricture group.Potential influencing factors such as gender,weight,gestational age,gap length and anastomotic leakage were examined for determining their association with postoperative anastomotic stricture. Results Among them,7 cases developed anastomotic stricture.Univariate analysis indicated that postoperative gastroesophageal reflux (χ2=6.046,P=0.014) and anastomotic leakage(χ2=7.757,P=0.005) were significantly associated with anastomotic stricture after thoracoscopy (P<0.05).Multivariate stepwise Logistic regression analysis identified anastomotic leakage (OR=19.167,95%CI:2.868-189.764,P=0.004) as an independent risk factor for postoperative anastomotic stricture in CEA children (P<0.05). Conclusions Anastomotic leakage is an independent risk factor for anastomotic stricture after thoracoscopic repair of type Ⅲ CEA.Optimizing surgical techniques and postoperative managements for preventing anastomotic leakage is crucial for enhancing postoperative quality-of-life in type Ⅲ CEA children.

参考文献/References:

[1] 蔡威, 孙宁, 魏光辉.小儿外科学[M]. 第5版.北京:人民卫生出版社, 2014. Cai W, Sun N, Wei GH.Pediatric surgery[M]. Edition V, Beijing:People’s Medical Publishing House, 2014.
[2] Rothenberg S.Thoracoscopic repair of esophageal atresia and tracheo-esophageal fistula in neonates:the current state of the art[J]. Pediatr Surg Int, 2014, 30(10):979-985.DOI:10.1007/s00383-014-3586-7.
[3] Yamoto M, Urusihara N, Fukumoto K, et al.Thoracoscopic versus open repair of esophageal atresia with tracheoesophageal fistula at a single institution[J]. Pediatr Surg Int, 2014, 30(9):883-887.DOI:10.1007/s00383-014-3554-2.
[4] 郑珊.先天性食管闭锁治疗的发展、现状与展望[J]. 中华小儿外科杂志, 2014, 35(8):561-563.DOI:10.3760/cma.j.issn.0253-3006.2014.08.001. Zheng S.Developments, current status and future prospects in the treatment of congenital esophageal atresia[J]. Chin J Pediatr Surg, 2014, 35(8):561-563.DOI:10.3760/cma.j.issn.0253-3006.2014.08.001.
[5] 黄金狮, 陈快, 陶俊峰, 等.胸腔镜手术治疗先天性食管闭锁并食管气管瘘69例报告[J]. 中华小儿外科杂志, 2014, 35(6):414-418.DOI:10.3760/cma.j.issn.0253-3006.2014.06.004. Huang JS, Chen K, Tao JF, et al.Thoracoscopic repair of congenital esophageal atresia in neonates:a report of 69 cases[J]. Chin J Pediatr Surg, 2014, 35(6):414-418.DOI:10.3760/cma.j.issn.0253-3006.2014.06.004.
[6] 梁翠萍, 耿岚岚, 杨敏, 等.球囊扩张治疗先天性食管闭锁修复术后吻合口狭窄疗效分析[J]. 中华小儿外科杂志, 2014, 35(8):577-581.DOI:10.3760/cma.j.issn.0253-3006.2014.08.005. Liang CP, Geng LL, Yang M, et al.Efficacy of endoscopic balloon dilatation in treating anastomotic strictures after repairing congenital esophageal atresia[J]. Chin J Pediatr Surg, 2014, 35(8):577-581.DOI:10.3760/cma.j.issn.0253-3006.2014.08.005.
[7] Parolini F, Leva E, Morandi A, et al.Anastomotic strictures and endoscopic dilatations following esophageal atresia repair[J]. Pediatr Surg Int, 2013, 29(6):601-605.DOI:10.1007/s00383-013-3298-4.
[8] 赵亮, 赵宝红, 吴晓霞, 等.胃镜下球囊扩张治疗食管闭锁术后吻合口狭窄疗效的探讨[J]. 中华小儿外科杂志, 2023, 44(9):789-793.DOI:10.3760/cma.j.cn421158-20230430-00203. Zhao L, Zhao BH, Wu XX, et al.Efficacy of gastroscopy assisted balloon dilation for anastomotic stricture after esophageal atresia surgery[J]. Chin J Pediatr Surg, 2023, 44(9):789-793.DOI:10.3760/cma.j.cn421158-20230430-00203.
[9] 贾炜, 钟微, 张靖, 等.先天性食管闭锁术后食管狭窄的诊治[J]. 中华小儿外科杂志, 2008, 29(12):711-713.DOI:10.3760/cma.j.issn.0253-3006.2008.12.003. Jia W, Zhong W, Zhang J, et al.Evaluation of postoperative anastomotic strictures in infants with esophageal atresia[J]. Chin J Pediatr Surg, 2008, 29(12):711-713.DOI:10.3760/cma.j.issn.0253-3006.2008.12.003.
[10] Pelizzo G, Destro F, Selvaggio GGO, et al.Esophageal atresia:nutritional status and energy metabolism to maximize growth outcome[J]. Children (Basel), 2020, 7(11):228.DOI:10.3390/children7110228.
[11] Ten Kate CA, Teunissen NM, van Rosmalen J, et al.Development and validation of a condition-specific quality of life instrument for adults with esophageal atresia:the SQEA questionnaire[J]. Dis Esophagus, 2023, 36(6):doac088.
[12] Okuyama H, Tazuke Y, Ueno T, et al.Learning curve for the thoracoscopic repair of esophageal atresia with tracheoesophageal fistula[J]. Asian J Endosc Surg, 2018, 11(1):30-34.DOI:10.1111/ases.12411.
[13] Griffiths N, James-Nunez K, Spence K, et al.The evolution of an interdisciplinary developmental round in a surgical neonatal intensive care unit[J]. Adv Neonatal Care, 2021, 21(1):E2-E10.DOI:10.1097/ANC.0000000000000741.
[14] Wang B, Tashiro J, Allan BJ, et al.A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States[J]. J Surg Res, 2014, 190(2):604-612.DOI:10.1016/j.jss.2014.04.033.

相似文献/References:

[1]孔赤寰 马继东 赵英敏 李 龙.球囊扩张治疗先天性食管闭锁术后食管狭窄的时机选择[J].临床小儿外科杂志,2010,9(04):0.
[2]贾炜 余家康 钟微 李瑞琼 何秋明 夏慧敏. 先天性食管闭锁12年疗效评价[J].临床小儿外科杂志,2012,11(01):20.
[3]钟微 王哲 余家康 李瑞琼. 先天性食管闭锁/食管气管瘘合并食管狭窄的治疗分析[J].临床小儿外科杂志,2012,11(03):214.
　[J].Journal of Clinical Pediatric Surgery,2012,11(01):214.
[4]洪淳 俞钢 朱小春. 先天性肺囊腺瘤样畸形40例诊疗分析[J].临床小儿外科杂志,2013,12(05):391.
[5]郑锦涛 唐华建 刘国庆. 产时子宫外处理技术治疗胎儿先天性肺囊性腺瘤样畸形的初步探讨[J].临床小儿外科杂志,2014,13(01):51.
[6]秦臻 王俊 蔡威. 鼻空肠营养管在ⅢA型先天性食管闭锁术后营养支持中的应用[J].临床小儿外科杂志,2014,13(02):157.
[7]朱海涛 沈淳 肖现民. 食管闭锁术后食管气管瘘复发再手术的临床分析[J].临床小儿外科杂志,2014,13(05):373.
[8]靳曙光 钟麟 向波.梭形先天性胆管扩张症35例诊断分析[J].临床小儿外科杂志,2015,14(04):313.
[9]苏琳,董倩,张　虹,等. 计算机辅助手术系统在先天性胆管扩张症[J].临床小儿外科杂志,2016,15(02):140.
[10]樊纬,黄金狮,陈快,等.Ⅰ型食管闭锁治疗中食管内张力延长技术的应用[J].临床小儿外科杂志,2017,16(04):360.

备注/Memo

收稿日期:2024-10-18。
基金项目:广州市科技项目(202201020614)
通讯作者:何秋明,Email:qiuminghe@foxmail.com

更新日期/Last Update: 1900-01-01